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Cerebral palsy - causes, symptoms, life expectancy

 
Cerebral palsy is an umbrella term used to describe a group of non-progressive disorders caused by damage to particular areas of the brain that affect a person's ability to control movement and posture.
 
The primary symptoms are muscle weakness and poor muscle tone but the nature and symptoms vary greatly between individuals, and from being mildly to severely disabling.  In New Zealand approximately 7000 people are affected by some degree of cerebral palsy.

Causes

Cerebral palsy occurs as the result of damage to specific areas of the brain, which may be apparent with sophisticated diagnostic tests such as MRI scans. The term cerebral palsy is used when this damage occurs early in life.  The damage that causes cerebral palsy may occur during foetal development, during childbirth, shortly after birth, or in early infancy.   Brain scan 1Cerebral palsy occurs in 2 to 2.5 per l000 live births and affects males and females in equal numbers.
 

Damage to the brain can occur for number of reasons. These include: 

  • Insufficient oxygen reaching the baby during pregnancy (eg: problems with the placenta or umbilical cord)
  • Insufficient oxygen reaching the baby during birth (eg: prolonged and/or difficult delivery)
  • Maternal infection during pregnancy (eg: German measles)
  • Premature birth or low birth weight
  • Blood group incompatibility between mother and baby
  • Severe jaundice following birth

Less commonly, the following can lead to damage to the brain and the development of cerebral palsy: 

  • Head injuries in early childhood
  • Illnesses in early childhood (eg: meningitis)
  • Genetic disorders
There are no significant racial or sociological differences in the occurrence of cerebral palsy.  Cerebral palsy does not become more severe with age but some difficulties may become more noticeable over time. 

Types of cerebral palsy

There are four main types of cerebral palsy. 
 
Spastic cerebral palsy
This is the most common form of cerebral palsy and affects 70% to 80% of all cerebral palsy sufferers.  It is characterised by stiffness and contractions (spasticity) of the muscles.  The lower legs may turn in and cross at the ankle (scissor gait).  Sometimes the long muscles on the back of the legs are so tightly contracted that the heels of the feet do not touch the ground and the child walks on tiptoe.  Spastic cerebral palsy is usually caused by damage to the area of the brain that controls movement.
 
Athetoid (Dyskinetic) cerebral palsy
This type of cerebral palsy affects 10% to 20% of all cerebral palsy sufferers and is characterised by slow, uncontrolled, writhing movements.  Muscles are weak and change from being floppy to being tense. Facial muscles may be affected causing distorted facial movements and drooling.  Speech may be hard to understand because of difficulty with controlling the tongue, vocal cords and breathing.  Uncontrolled movements may increase during times of stress, and may disappear when sleeping. Athetoid cerebral palsy is caused by damage to the middle part of the brain.
 
Ataxic cerebral palsy
This is the least common form of cerebral palsy, affecting 5% to 10% of all cerebral palsy sufferers.  It is characterised by poor co-ordination of movement and poor muscle tone.  The sense of balance and depth perception is affected and there is a lack of co-ordination when standing and/or walking.  Movements may be shaky and a tremor may be present.  This type of cerebral palsy is the result of damage to the cerebellum at the base of the brain.
 
Mixed cerebral palsy
This type of cerebral palsy affects about 10% of all cerebral palsy sufferers. In this type of cerebral palsy several areas of the brain are affected, so the condition may involve several of the characteristics mentioned above.
 
Cerebral palsy, particularly spastic cerebral palsy, can be further classified according to the part(s) of the body that are affected eg: If only one limb is affected, it is called monoplegia. If two limbs are affected, it is called diplegia.  If the arm and leg on the same side are affected, the condition is called hemiplegia. If all four limbs are equally affected it is called quadriplegia.

Symptoms

In infancy, the main symptoms of cerebral palsy are muscle weakness and a lack of muscle tone (hypotonia).  Early signs of cerebral palsy usually appear before the age of 18 months.  It may be noticed that developmental milestones such as smiling and rolling over are delayed or not reached.  As a child develops, other symptoms may appear.  These may include: 

  • Floppiness
  • Muscle stiffness and/or spasms
  • Slow, awkward or jerky movements
  • Involuntary movements
  • Drooling
  • Speech impairment
  • Difficulty maintaining bladder and/or bowel control
  • Hand tremors and the inability to identify objects by touch

Often the cerebral palsy child has normal intelligence.  However, there may be mild or severe intellectual impairment in some children.  Other difficulties and medical conditions occur more frequently in children with cerebral palsy.  These include: 

  • Seizures
  • Vision impairment
  • Hearing difficulties
  • Difficulty with spatial perception
  • Difficulties with chewing and swallowing
  • Learning difficulties

Treatment  

Cerebral palsy cannot be cured but it can be managed.  A management plan aims to help the child achieve maximum potential in growth and development through the combined efforts of  doctors, therapists, educationalists, parents and the child.  Motivation is an important factor in how well any management plan will succeed.  Emphasis is placed on the integration of games and play into the programme. 

Physiotherapy
Physiotherapy plays an important role in the management of cerebral palsy.  Exercises and activities are designed to increase the function of those parts of the body that are not affected by cerebral palsy and to maximise the function in parts that are affected.
 
Occupational Therapy
Occupational therapy helps with daily living needs.  These include how to dress, hold a cup, clean teeth etc, as well as vocational training.
 
Speech Language Therapy
Where speech is affected, speech language therapy aims to maximise communication skills.  It can also be useful where there are swallowing difficulties.
 
Educational Therapies
There are a number of different educational therapies that can be effective in the management of cerebral palsy.  Examples include:
 
Conductive education
 This educational system was developed by Professor Andras Peto in Hungary. It uses a holistic approach that encompasses all aspects of learning such as motor skills, cognitive development and social and emotional skills. The programme was developed specifically for children with movement disorders.
 
Bobath
This educational therapy has a neuro-developmental approach.  It is based on the premise that cerebral palsy is due to interference with the development of normal postural control against gravity.   Management is aimed at increasing co-ordinated movement patterns.
 
Feldenkrais
This therapy is a form of education that uses gentle movement and directed attention to improve movement and enhance functioning.
 
Medications

Different medications can be useful in managing the symptoms of cerebral palsy. These include: 

  • Anticonvulsant medications to control seizures
  • Muscle relaxant medications to ease the tension of contracted muscles
  • Anticholinergic medications to help control urinary incontinence, tremors and drooling
Injections of the neuromuscular-blocking agent Botox (botulinum toxin), which acts by blocking signals between the nerves and muscles, is also used to help relieve muscle spasms and stiffness in some children with cerebral palsy.  When injected directly into a muscle affected by cerebral palsy, it works to relax the muscle and helps to reduce spasms and stiffness. The effects of the Botox injection last for three to six months, at which time the injection needs to be repeated for the benefits to be maintained.
 
Surgery
Where there are difficulties with severe muscle contractions, surgery may be recommended.  Surgery usually involves lengthening tendons (the strong fibrous tissue that attach muscles to bone) or tendon transfers.  This procedure can be done with the elbows, shoulders, back of the heel and other areas of the body.  WWhere nutrition is inadequate, surgery to insert a feeding tube into the stomach may be required.
 
Alternative therapies
Some alternative natural therapies, such as acupressure, cranial osteopathy, acupuncture and massage, may be useful in managing symptoms such as muscle spasms.

Life expectancy

Life expectancy with cerebral palsy is related to the severity of the condition and co-existing medical complications such as cardiovascular and gastrointestinal problems.  In general, people with milder forms of cerebral palsy have life spans that approach those of the general population.  People with severe forms of the condition are likely to have considerably reduced life expectancy.  With that said, due to earlier diagnosis, improved medical care and the use of stomach feeding tubes for nutritional support, the life span of those severely affected is increasing.

Support and information

The Cerebral Palsy Society provides support, information and advocacy.  Their contact details are as follows:
 
Cerebral Palsy Society of New Zealand
P O Box 24 759
Royal Oak
Auckland
Freephone: 0800 503 603
E-mail: cpsociety@cpsociety.org.nz
Website: www.cpsoc.org.nz  

References

Abdel-Hamid, H.J. (2013) Cerebral Palsy. Medscape Reference: Drugs, Diseases & Procedures. WebMed LLC. http://emedicine.medscape.com/article/1179555-overview
Cerebral Palsy Society of New Zealand (Date Unknown) Cerebral Palsy. Pamphlet Cerebral Palsy Society of New Zealand (Inc). Auckland. .
Cerebral Palsy Society of New Zealand (2007) Types of Cerebral Palsy. Cerebral Palsy Society of New Zealand (Inc). Auckland  www.cpsoc.org.nz/CP/types.htm#top
O'Toole, M.T. (Ed) (2013) Cerebral Palsy.  Mosby's Dictionary of Medicine, Mursing & Health Professionals (9th ed.). St Louis:elsevier Mosby.
Polzin, S. J., Odle, T. G. (2006) Cerebral Palsy. The Gale Encyclopedia of Medicine. Third Edition. Jacqueline L. Longe, Editor. Farmington Hills, MI: Thomson Gale,
 
Last Reviewed – 13 May 2013 

 

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